Kidney Stones on The Rise in The United States

Speaker 1: Well, they affect around 10% of all Americans at some point in their lives, but now according to a new study recently released by the Mayo Clinic, the reported cases of kidney stones are increasing. The study found that they have become even more common over the past 30 years, especially among women. So what's causing this? What can be done to prevent them? Joining us, once again, brought in the expert to help answer some of these medical questions with some of the top trending medical topics of the week is Dr. Ali Kasraeian. Good to see you. Thanks for being here. You got to get the tie all straight and set up.

Dr. Kasraeian: Thank you for having me.

Speaker 1: Yeah, so this is interesting. You say, coming out of the Mayo Clinic, that they are becoming more and more prevalent. So before we get into why that is the case, in your opinion, let's talk about what they are.

Dr. Kasraeian: So kidney stones are — finally something related to my field of expertise, actually, urology —

Speaker 1: Urologist! There you go.

Dr. Kasraeian: Making the national media, which is great, besides prostate cancer.

So, one in 10 men and women, so one in 10 people in their lifetime, have a risk of getting a kidney stone. So, that's your lifetime incidence of kidney stones. The thing to be mindful of is what are kidney stones?

So, basically, the most common types of stones are calcium oxalate stones, more than 75%. So you have calcium and oxalate crystals that meet, they form a crystal, and if they get too big, they can block the drainage of your kidney. So the meat of the kidney makes urine, they dump it into this thing called the ureter that takes the urine to the bladder. If that stone gets down there and blocks things, it can potentially cause pain as that tube stretches.

Speaker 1: If you have ever met somebody who has ever had one of these things, they say they are extremely painful.

Dr. Kasraeian: People say that it's more painful than natural childbirth.

Speaker 1: I have heard some people say that. Okay, so what can be done to prevent them then? What can we do?

Dr. Kasraeian: Absolutely. The common things that you can do that are very simple without knowing the specifics of your stone composition or your metabolic workup that can be done to figure out what in your urine environment sets you up for stone formation. One is hydration. That's probably the most important thing, especially somewhere like Florida, where it's hot.

Speaker 1: Yeah, that was going to be my first thing. When people say, "I need to drink more water." No, you really do. They ward off kidney stones.

Dr. Kasraeian: Absolutely. We talk about that. Look at the color of your urine. If your urine looks like tea or apple juice, it's too concentrated. It's too dilute. So you want to dilute it more. It's not dilute enough. It needs more fluid to essentially keep the crystals from touching each other. So look at your color. You want to be a clear yellow color from that standpoint. That's one.

Speaker 1: Good reference. Good to know.

Dr. Kasraeian: Yeah, and you can Google this actually. There are a lot of great little markers that go from very light yellow to very, very dark brown. And the other one is you want to decrease the amount of salt in your diet.

Speaker 1: Which is tough.

Dr. Kasraeian: For some people, yeah, it is very, very difficult. And if you look at things in cans, prepackaged foods, they're filled with salt.

The other one is decreasing the amount of animal fat and animal protein in your diet because they can potentially lead to stone formation. And with stones, it's kind of like real estate. It's about size and location. So if you have a small stone that's high, it's unlikely to block anything. If it's in the actual kidney portion of that drainage tube.

Speaker 1: So would you even know it's there, and would it even be a problem?

Dr. Kasraeian: You may not. So a stone that's five millimeters there's something interesting to think about. If you have a stone that's bigger than five millimeters, you have a harder time passing it. If it's smaller than five millimeters, it's an easier time passing. And five-millimeter stones, you have about a 50% chance of passing on your own with hydration and certain medicines that can relax you.

Speaker 1: Would you even know?

Dr. Kasraeian: You may not if it's small, and that's the interesting thing about this study. So they found a fourfold increase in stones for women, a twofold increase over three decades from 1984 to 2012. However, the incidents of symptomatic stones that hurt were the same. What they found was a higher incidence of asymptomatic stones, essentially stones less than three millimeters, that they found incidentally on imaging.

Speaker 1: So is that just the ability to detect these things better that's leading to these numbers?

Dr. Kasraeian: So one thing that the researchers alluded to is the fact that we are doing a lot more CT scans, not only for just evaluation of stones but just in general. In 2016, over 80 million CT scans were done compared to 1995, where we had 2.7 million.

Speaker 1: So more people may be affected by these things, but they might not even know it.

Dr. Kasraeian: Or they may have small ones that aren't causing symptoms.

Speaker 1: Are not causing symptoms. Now, is it a problem if you have one of these and you are not doing anything to take care of it? I mean, once it gets to a certain point, you can't ignore it.

Dr. Kasraeian: So, it's really an issue of size. So if the stone starts getting bigger, it can potentially cause-

Speaker 1: And then you'll start having the warning symptoms, which are what?

Dr. Kasraeian: Extreme pain. So the thing that you hear about renal colic, people throw around, and it is pain starting in the back and wraps around and goes down towards a groin, basically following the path where the stone is going to go down and the nerves that refer pain off this issue. So that's a big thing that you would notice. And if anyone has seen someone have a stone or have had a stone themselves, it's probably one of the most painful things. So avoiding it and minimizing risk is a big thing. So be mindful of this.

One of the things with the study, it's not that everyone's worried that they're going to have a stone that's going to drop and block and cause pain, but hydration is important, decreasing salt in your diet, being mindful of moderation with animal fat and protein.

The other thing is obesity. So obesity has been shown to increase certain factors that could potentially cause stones, including the way that your body takes up more calcium and puts it more into the urine, and both of those things can potentially increase your risk of stone formation.

Speaker 1: So it really goes back to what we say with a lot of medical conditions, right? It's eating right. It's exercising. And in this case, it's really making sure that you drink your water.

Dr. Kasraeian: Absolutely. Hydration is a very important thing. As a stone former, you want to urinate about two liters a day. So you want to make sure that you drink enough to do that. So you need to drink actually more than two liters, which is about a two-liter bottle of Coke. But again, caffeine-

Speaker 1: Not Coke.

Dr. Kasraeian: Not Coke. I mean, those things can also increase your risk of stone formation. So water is best. Sometimes adding a little lemonade in there can potentially-

Speaker 1: That's right. Okay.

Dr. Kasraeian: Before we finish up, I also want to... Our hearts go out to the people in Parkland with everything that happened. We've just been talking about Stop the Bleed and going to bleedingcontrol.org. Make sure that you pay attention to this stuff because it really wasn't a week ago that we were discussing these things. We did a radio show on the topic, and unfortunately, we have such a tragedy that we have to deal with. So be mindful. And our hearts go out to the families, the children, and everyone in that community because it's a heart-wrenching thing, and it's sad that we have to deal with this stuff. And hopefully, smarter heads will prevail, and we'll be able to find a way to decrease these things.

But what you can do yourself is bleedingcontrol.org. Learn how to stop the bleed because if you're in that situation, we can save lives by not being a bystander, and you can be a lifesaver.

Speaker 1: All right, good deal.

Dr. Kasraeian: Sure.

Speaker 1: Appreciate you being here as always. You can get more information from Dr. Kasraeian, and I'm sure you'll be doing more on Stop the Bleed on your weekend radio show, which is on WOKV. It's every Saturday starting at 5:00 PM. You can call in, ask whatever questions that you would like. You can also visit his website for more information.